Background

The Orthopedic Workshop and Physiotherapy Clinic (OWPC) was opened in 2003 in Maimana city, Faryab province, to provide orthotic and assistive devices to people living with disability (PWD), accompanied by physiotherapy services.

In 2007, a pilot Community-Based Rehabilitation (CBR) project began, to enable outreach and advocacy to rural communities in Faryab province. CBR became a permanent part of the project design and for the last several years the project has been recognised as CBR-OWPC.

Since 2014 IAM has been unable to sustain a residential expatriate team in Maimana city for reasons of security. Even so, the project has been managed and led ably by the national team, and enjoys the support and respect of local government and civil society as well as international NGOs active in the sphere of disability work.

The CBR part of the project was stopped in June 2017 and the project now consists of the OWPC.

Purpose/objective

The specific objective of this evaluation is to conduct an assessment of the project to verify as far as possible that the project is active, functional, relevant and that it achieved its aims over the past few years whilst receiving Digni/MCCN funding.

The following criteria should be considered as standard in every IAM developed ToR: Effectiveness, Impact, Relevance, Efficiency/Strategy, Sustainability, Coordination and Coherence.

Methodology

The methodology for this evaluation consisted of key informant interviews, beneficiary interviews, observation, and a desk study of reports. The number of beneficiaries interviewed was limited because of security concerns and time constraints. The evaluation therefore relied heavily on key informant interviews, observation and a desk study of reports

Key findings

Project outputs are positive as a whole. A wide range of activities has been pursued, and ambitious goals were set and pursued. For instance, the goal for providing orthopaedic devices rose from 600 (2014) to 800 (2015) and then to 1200 (2016), a 100% increase over two years. Similarly, the goal for assistive devices rose from 1600 (2014) to 1800 (2015) and then to 2500 (2016).

Gender equality: Overall the project has a goal of a third of beneficiaries being women. The overall percentage of women was reported to be 47%. Vocational training was dominated by women, 72%.

The goal of the project is to partner with PWD in Faryab Province to help them reach their greatest potential. The project has made a significant contribution to helping PWD reach their greatest potential. PWD can now sit/stand on their own, walk, study, and work. CWD are in schools; PWD have had vocational training, received loans and started their own businesses; PWD have gained employment in NGOs and government departments; PWD learn to play sports and competed in tournaments; and ingrained cultural norms such as marrying within the extended family are being challenged resulting in disability being prevented. Because of changing perceptions about disability, PWD now can live with increased dignity and much less shame.

Changed circumstance. The project has had to focus more on Maimana city and the immediate area around it when project villages were threatened or over-run by AOGs. However, project staff continued to go to many villages despite the dangers, assessing the situation continually. The project has been remarkably effective in the changing and challenging circumstances in Maimana and Faryab province.

Impact, Transformation of lives. Each of the 3,823 people that have received orthotic devices over the last five years has a story to tell – of a tragedy and then finding hope through the work of the project. Their lives have been impacted in a profound way by getting the devices, receiving physiotherapy, receiving gait training, the on-going maintenance/replacement of their devices, and even by seeing the disabled workers in the clinic leading productive and meaningful lives. The OWPC is the only place of its kind in the North East of Afghanistan, so it is unlikely that many of the 3,823 people would have been helped if the project had not existed. Other PWD have received vocational training and loans to start small businesses, or have found work through the advocacy work of the project.

Efficiency/Strategy: The project has achieved most of the goals set out in the yearly log frames within the following year. Two exceptions are the handing over of the clinic to be run by the hospital and training up physiotherapy assistants.

Exit: Fortunately, the project has secured funding from Caritas for the next three years setting it up well for the future. In addition, the continued technical support from Mr Victor Theissen, and in-kind support of materials from the ICRC should enable the project to exit IAM and transfer to RCY without too many problems. There is every reason to believe the transfer will be successful and the project will continue to benefit the target population.

Recommendations

Community based, participatory approaches such as CBR have been criticized for pushing work that should be handled by the state onto already struggling communities – work such as operating DCs and ODPs, identifying PWD, referring them to services, and educating people about issues such as congenital disabilities from marrying cousins, proper care for pregnant women, and the need for immediate treatment of club foot. While there is some validity in this point of view, in Faryab province and most of Afghanistan however, unless the community takes on this work, it will simply not get done.

The amount of money needed for the government to do this is not available. For disabled people to be helped and supported at this time in Afghanistan’s development community involvement is necessary.

Community based approaches have of course added benefits such as the community taking more ownership of their own development – a fundamental value for proponents of community development approaches.

Comments from the organisation

Misjonskirken Norge is very pleased that our partner found a solution for a final-evaluation of the project. That is difficult in the context. Misjonskirken Norge would normally expect a report with more recommendations. Since the project ended in 2017 the evaluation is more a summary of what is achieved than an input with recommendations for the future. Nevertheless, we expect that our partner has learned from the evaluation.